Turner, Sophia Form VS.si. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gr This Permit an be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE 9F
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No ..
Dist. Nosh'(" .County.. .. orlrC �--G-6 "?7
(If city, give streaddree
Name of deceased. Veteran
� 1 (If veteran, give name of War)
!N Single, married, widowed, / ,7
Sex... Color or divorced (wnte the word). : Date ofMi4:3 19
Age 2" Year 7 Mon .`?. .Days Birthplace "�-�'' 'ice ` ',
Cause of Death .. ,,-�4- r... �( -i ti-f^..� '�Y
Certificate was signed M.D.ily. ' `zc'"-,''
Address ' 3 • "-e
Place of Burial (or Removal) --; -7 -.—' — /
(If body is to be oraylly held,fill in,space cater) L7
Cemetery '-- ) ----'4 .. Date of Burial f 19:.?..
(If body is to be temporarily held,Jill In space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Nuttxr-and on to basis thereof IMEREBY GRANT A PERMIT CZ/e6 1 2
».T J
ame) ( ' dress)
�L the d
the.... , �-t.: �.,...._to old tempor , ly nd...." ... .... - y•
(y�6e'rtake or n having charge t1f,_eor ) (Inter, emo r erwise disnose of(state how))
Dated CJ1 19 -1 : " (Signed)� . .. �
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any peat of the State (subject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEX'lUN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date CliV 9' was (Jrd 19
(Interment or eresm43m)
(Name of Cemetery, Crematorium, etc
.
Cam.
Section Lot No.0 Grave No.
(Signed) _/ Le%z-il ( 7 /
(Person in charge)
Address • G' Z6 Z
Person in charge Heist return this Permit to
the Registrar of his District within SEVEN (7) DAYS
from above date. If no person is in charge, the
FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATE-
MENT, write across the face of the Permit the words
"No person in charge," and FILE PERMIT WITHIN THREE
(3) DAYS with the Registrar of District in which
cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOLLARS
NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.